Ganz P A, Schag C A, Cheng H L
Department of Medicine, UCLA-San Fernando Valley Program, VAMC, Sepulveda 91343.
J Clin Epidemiol. 1990;43(1):75-86. doi: 10.1016/0895-4356(90)90059-x.
Quality of life (QL) assessment is an increasingly important component of clinical research, especially with cancer patients. The literature strongly supports the view that QL should be assessed by the patient rather than the clinician. While clinical parameters such as performance status or toxicity ratings may bear some relationship to QL, they are not a substitute for its measurement. In spite of these observations, clinicians have been reluctant to accept the need for patient-rated measures of QL. In this paper, data from a sample of 109 newly-diagnosed breast cancer patients were used to examine the relationship between expert-rated measures and a patient-rated measure of QL; to determine whether the Cancer Rehabilitation Evaluation System (CARES), an instrument for assessing the rehabilitation needs of cancer patients, is a measure of QL; to explore whether there are any medical, social or demographic variables which the clinician can use to predict how patients assess their QL; and to determine which variables (expert-rated scales, medical, social or demographic variables, or rehabilitation needs) have the most effect on how patients evaluate their QL. In this sample, patient ratings of QL were widely distributed and were only moderately correlated with the expert-rated Karnofsky Performance Status (r = 0.53) and Global Adjustment to Illness Scale (r = 0.59). In addition, there were no significant correlations between important clinical variables (axillary node status, type of surgery, receipt of chemotherapy) and patient-rated QL. Among the clinical variables and instruments studied, the Global CARES score demonstrated the best correlation (r = -0.74) with the patient-rated assessment of QL. A stepwise multiple linear regression procedure was performed with QL as the dependent variable in order to identify which factors accounted for the most variance in patient assessment of QL. The potential predictor variables used in this procedure were chosen from among those that would be available to a clinician. The Global CARES score was the best single predictor of QL, accounting for 55% of the variance, followed by Karnofsky Performance Status, the Medical Interaction and Sexual summary scales of the CARES, and the patient's educational status. Data from the CARES provided additional descriptive information about the type and frequency of rehabilitation problems experienced by these patients in relation to their ratings of QL.(ABSTRACT TRUNCATED AT 400 WORDS)
生活质量（QL）评估在临床研究中日益重要，尤其是对于癌症患者。文献有力地支持了应由患者而非临床医生来评估QL的观点。虽然诸如身体状况或毒性评级等临床参数可能与QL存在一定关系，但它们并不能替代对QL的测量。尽管有这些观察结果，临床医生一直不愿接受需要患者自评QL的测量方法。在本文中，来自109名新诊断乳腺癌患者样本的数据被用于检验专家评定指标与患者自评QL指标之间的关系；确定癌症康复评估系统（CARES）这一用于评估癌症患者康复需求的工具是否为QL的一种测量方法；探究临床医生是否可利用任何医学、社会或人口统计学变量来预测患者如何评估自身的QL；以及确定哪些变量（专家评定量表、医学、社会或人口统计学变量，或康复需求）对患者评估自身QL的影响最大。在该样本中，患者对QL的评分分布广泛，且仅与专家评定的卡氏功能状态（r = 0.53）和疾病整体适应量表（r = 0.59）呈中度相关。此外，重要临床变量（腋窝淋巴结状态、手术类型、是否接受化疗）与患者自评QL之间无显著相关性。在所研究的临床变量和工具中，CARES整体评分与患者自评QL评估的相关性最佳（r = -0.74）。以QL作为因变量进行逐步多元线性回归分析，以确定哪些因素在患者对QL的评估中占最大方差。该分析中使用的潜在预测变量是从临床医生可获取的变量中选取的。CARES整体评分是QL的最佳单一预测指标，占方差的55%，其次是卡氏功能状态、CARES的医疗互动和性总结量表，以及患者的教育程度。CARES的数据提供了有关这些患者在与QL评分相关的康复问题类型和频率的额外描述性信息。（摘要截选至40０字）
